Orthodontic Services

Cleft-craniofacial, special needs, and routine orthodontics for the entire family.

UPMC Children's Hospital of Pittsburgh has orthodontic specialists dedicated to the care of patients with craniofacial differences of face and jaw (such as cleft lip and palate or other conditions), patients with special needs, and routine orthodontics for the entire family.

Treatments and Services

Phase 1 Orthodontics: Straightening crooked teeth with braces, crossbites (palate expanders), crowding and other considerations
Phase 2 Orthodontics: Alignment of teeth and bite correction using traditional or clear braces, or Invisalign/clear aligner therapy
Nasoalveolar molding: Appliance treatment to reduce the size of the cleft gap and shape the nose in patients with cleft lip and palate. This prepares your baby for lip closure surgery.
Alveolar bone grafting preparation: Widening/palate expansion the upper jaw and tooth movement in patients with clefts of the gum ridge to prepare for surgical replacement of missing bone in the cleft.
Orthognathic surgery and distraction osteogenesis – The orthodontists work closely with the surgical team to plan for and prepare patients for the most appropriate surgical interventions. Braces, custom appliances (if needed) and monitoring of the bite are performed.
Infant ear molding for cartilage differences in newborns

Stahl's ear
Prominent/Protruding Ear
Helical rim differences
Conchal crus
Constricted ear

The center also offers surgical treatment for ear differences. UPMC Children's offers a variety of orthodontic services for our pediatric patients.

Our Orthodontic Services

We specialize in straight smiles and excellent bites! Orthodontic care is important to establish the best possible dental health and function. This is accomplished through traditional metal or ceramic braces and clear aligner therapy. The team, orthodontic staff, and doctors work closely with you and your child to discuss your goals, treatment options, and treatment progress. Care is available for patients of the Cleft-Craniofacial Center and also those in the community seeking treatment for their entire family, including adult orthodontic care.

Before (Unilateral cleft lip and palate) After (implant planned for missing lateral incisor)

Before – Adult care, centerline deviation, right canine substitution

After

Orthognathic or jaw surgery is a common option for patients who have bite imbalances related to the position of the jaw. The orthodontist works closely with the surgeons at Children's to ensure the bite and the movement of the jaw is in harmony with the face.

Maxillary hypoplasia (a small upper jaw), is common in patient's with a history of cleft lip and palate. Surgery to bring the upper jaw forward is a common corrective option. Other surgery options include movement of the lower jaw and lower chin and distraction osteogenesis. Braces are typically started a year prior to surgery. They are important during and after the surgery to hold the new bite together with orthodontic elastics from the top to the bottom jaw. The braces remain on after jaw surgery to perfect the bite and appearance of the smile.

Before braces and jaw surgery

After jaw surgery

Preparation for alveolar bone grafting

Patients with cleft lip and palate often present with alveolar clefts or missing bone in the areas of the gum ridge opening and teeth beside it. Alveolar bone grafting (ABG) aims to provide bone into these areas to allow for healthy permanent tooth eruption.

The need and appropriate timing of alveolar bone grafting is often assessed at age 6. Timing of surgery coincides with eruption of the permanent lateral incisor or canine at ages 7 to 12. These two teeth are the teeth most often adjacent to the gum ridge cleft. Bone is required to maintain these teeth for the long term.

Your surgeon and orthodontist work closely together to coordinate your care. Prior to the ABG, an orthodontic expander and braces may be recommended to provide better outcomes for the graft and dental alignment. The surgeon will then be able to use bone, most often from the hip, to fill the alveolar cleft. Either the orthodontic expander or a retainer will be used on the teeth to hold it in place for a few months while the graft heals. During this time, good oral hygiene is important to improve graft success. X-rays are provided six months after the graft to evaluate its healing.